| NPI | 1982987582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302034587) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03227966) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2014-06-06 |